Wholesale GMS contract negotiations may be off the table, says BMA GP committee chair

Exclusive Wholesale GMS contract negotiations may be off the table as they were a ‘Wes Streeting commitment’ rather than a Government one, the leader of English GPs has said.

Speaking at Pulse LIVE in Birmingham, Dr Katie Bramall said that the Government is ‘still quite keen’ to move forward with ‘substantive contract reform’, but that this might not happen in the way the union wanted with a wholesale new contract.

Last year former health secretary Wes Streeting had formally committed to renegotiating a ‘completely new’ national GP contract.

Pulse then revealed that the Government would be bringing forward its own proposals for ‘a reform of the GMS contract’, and the BMA’s GP Committee had pushed to start the negotiations immediately, but these have not materialised so far.

Dr Bramall said: ‘The comprehensive spending review was pretty much a year ago, and that’s Treasury’s roadmap for how they’re going to fiscally endure the next three years.

‘They always leave a year before a general election for a bit of a pre-election splurge, where they hold back a bit of money and then spend it at the end, so they can point to nice things on an election trail.

‘But that comprehensive spending review set rules around a limit of 2.8% for the NHS between now and the end of parliament, so for 2025/26, 2026/27 and 2027/28, your investment is locked, and trying to get anything more is going to be impossible.

‘I’ve said to the Department of Health “how does that square with the new contract?” And they have said “well, this was Wes Streeting’s commitment, it wasn’t this Government’s commitment”.

‘I think they’re still quite keen to move forward on substantive contract reform, but not in the way that we would want, and I can see it happening piecemeal.’

She said what the BMA would want to see was ‘scoping discussions’ now, followed by negotiations this Autumn.

‘You have a 90-day pause where you jointly consult other stakeholders over July and August. In September, October, you commence negotiations proper, you put the contract to a vote in the second half of 2027 implementing from April 2028,’ she said.

However, Dr Bramall said that a ‘big barrier’ to this happening was a ‘lack of money’, adding that the ‘biggest red flag’ was the Government-commissioned review of the Carr-Hill formula for GP funding, announced in October last year and meant to last six months.

She said: ‘There’s been silence. My big worry is that we’re looking at a fixed funding envelope where you’re basically taking all the chairs on the deck of the Titanic, throwing it up in the air, and to see where they land, when practices have been managing on established Carr-Hill formulae going back to 2004 based on data that goes back to the 1991 census.

‘I’m not saying it’s fit for purpose, far from it, but you can’t just change everything for the sake of changing it, because you’ll just have even more winners and losers, and even more volatility of practice sustainability. So, that is a big concern for me.’

It comes as the GPC is currently coordinating collective action for practices against this year’s imposed contract and the lack of concessions from the Government around unlimited access.

Dr Bramall said she has ‘been trying to be really pragmatic’, suggesting to the Government that practices should be able to switch off online access at 4pm rather than 6:30pm.

NHS England said that practices have been given the possibility to reach ‘bilateral agreement’ with their ICB when capacity is reached, although only in exceptional circumstances – and practices need to have put systems in place to avoid getting overwhelmed by such demand.

Dr Bramall said: ‘I think a lot of the guidance that is going to come out around exceptional pressures is going to be quite pragmatic and helpful.

‘We’ve got skeleton staff at an ICB level, so I think the risk of breach notices is going to be negligible, and I think they know that.

‘Because they’ve got no staff to manage it, they’re not interested in breaching practices who are genuinely trying to do their best.

‘If you’re taking the piss and you’re switching off at 8.05, that’s a different matter, but, but if you’re literally doing the best you can with what you’ve got, I think they’ll be supported.’

Pulse has contacted the Department of Health and Social Care for comment.

The Government previously responded to a list of proposals put forward by the BMA during the consultation for the 2026/27 GP contract, promising that some of these will be part of future reforms.

Pulse will be back in Birmingham 21-22 June for the Community Pharmacy and General Practice Conference, co-hosted by Cogora. GPs can sign up to attend for free here.